Story by Claire Ruch
There’s something Pavlovian about a therapist’s office.
Maybe it’s the nice temperature, not too hot and not too cold. Maybe it’s the white noise machine that murmurs softly or the diffuser that wafts lavender through the air.
For Jazmine Bunch, it’s the brown velvet couch – her environmental cue to open up, the so-called ringing bell that makes her mouth water.
She slouches into the cushions, gets comfortable and unloads her anxieties. Her therapist listens, sitting just a few feet away.
But what happens when those cues disappear and therapy moves to the digital land of screens?
As the coronavirus reached pandemic threshold and social distancing entered our vernacular, face-to-face counseling took a virtual turn.
COVID-19 specifically fueled the uptick in virtual counseling known as teletherapy. Mental health practitioners had little choice but to go digital when states implemented mandatory stay-at-home orders.
The pandemic itself has riddled folks with uncertainty, prompting a spike in the number of people who feel mentally distressed – whether or not they seek out help and an official diagnosis.
A recent survey from the Kaiser Family Foundation found 45% of the United States’ population reported feeling distressed due to circumstances surrounding the coronavirus. Concerns include financial strain, separation from loved ones, social isolation and fear of infection, especially for frontline caretakers and essential workers.
Dr. DeAnna Murphy, a licensed professional counselor who practices in Chapel Hill, says she’s seen an increase in consumers dealing with anxiety and depression.
Some are returning individuals who sought out teletherapy under the stressors of quarantine, ones she counseled months or even years before the pandemic.
Murphy says people have called back and explained, “‘You know what, I don’t think it was a good idea for me to stop therapy.’”
Others are individuals she saw in-person, up until the pandemic, who made the switch to virtual counseling out of necessity.
Those are people like Bunch, a rising senior at UNC-Chapel Hill, who lost access to the brown velvet couch but forged ahead with online sessions.
Instead of driving to appointments, folks struggling with mental illness now find themselves logging on to Zoom. Rather than transportation, they need reliable internet.
The biggest challenge: recreating that safe space inside their own homes.
‘A bit of a strain’
Bunch has seen her therapist since August. When her first virtual appointment rolled around this March, she opened up her laptop and sat down at the desk in her apartment. She swapped the brown velvet couch for a black butterfly chair and a blanket draped across her legs.
The session began, and she couldn’t help but think, ‘I hate this. It feels so impersonal.’
She scheduled another session in two weeks, anyway. Bunch had built a rapport with her therapist, who finally validated her after a rocky first acquaintance with counseling, so she felt confident they’d work out the kinks.
Maybe she’d get used to the virtual chasm.
Several online appointments later, Bunch still prefers meeting in person. The words she uses to describe the shift to digital are lukewarm: “fine,” “OK,” “a bit of a strain.”
Bunch says teletherapy allows her to be less honest because her therapist can’t read her body language. The screen only captures her face, limiting access to her emotions.
“I can hold back on how I’m really feeling,” she says, “and of course that doesn’t help either one of us.”
But Bunch remains grateful for these earmarked times to discuss her emotions. Her anxiety has skyrocketed during the pandemic, so putting therapy on pause was never an option.
COVID-19 ushered in her university’s closure, cancelled her summer internship and curbed time spent with her friends. Bunch says social isolation “drains” her the most because she’s an extrovert.
Without other people to derive her energy from, she tries to see teletherapy as a gateway rather than a barrier to human interaction, one that comes with a healthy dose of professional advice.
‘A saving grace’
For some, teletherapy has been an adjustment. For others, it’s been a lifeline.
Lauren Shumpert, a 23-year-old college advisor with AmeriCorps, has worked from her apartment in Kill Devil Hills where she relies on video chat to mentor local high school students.
She lives with generalized anxiety disorder and major depression. When she moved to the Outer Banks a year ago, Shumpert committed to face-to-face counseling.
At her therapist’s office, she can unload her burdens and “walk away with a different perspective,” she says. “It’s Pavloved my brain into opening up.”
That’s why Shumpert was reluctant to give up her in-person sessions. She worried teletherapy would be disingenuous.
“Would it feel like my therapist’s really listening? Would it feel the same? Would I feel that safe feeling I feel in the office?” Shumpert asked herself.
As the pandemic worsened, the loneliness intensified. She leaned on her friends, family and roommate. But Shumpert could tell everyone was emotionally overloaded, so she scheduled an appointment.
At the end of March, Shumpert logged on to an encrypted website and answered her therapist’s incoming call.
“I was shocked at how well we were still able to connect over video,” Shumpert says.
She appreciates the secure platform and admits she underestimated just how cathartic conversations through a screen could be. Virtual sessions even boast perks that can’t be found in the office, like on-screen cameos from her therapist’s cat.
“Having a neutral person in my life who is prepared to hear all my fears and help me work through them has been a saving grace,” she says.
Shumpert doesn’t mind the extra effort it takes to recreate a safe atmosphere, either. Teletherapy actually provides some semblance of structure when her days spent quarantining make time stretch out like silly putty.
“It’s nice to have something on my calendar and know that there are things coming up in my life instead of just this vast expanse of nothingness for the foreseeable future,” she says.
Shumpert plans to continue with online sessions when social distancing mandates end and her calendar fills back up.
She says virtual counseling is more convenient because it eliminates travel time and introduces flexibility. Instead of asking her boss for time off, Shumpert can keep her appointments private and schedule sessions after work when she’s home.
The other day, she took to Facebook and urged her digital network to give teletherapy a chance.
“If you’ve been putting off therapy and you have some free time right now,” Shumpert wrote, “treat yourself to a (video) session with somebody who can take anything you dish out.”
A privilege, not a right
While those like Shumpert have thrived and some like Bunch have managed, others have fared worse in the quick switch to teletherapy.
Mental health counseling is a privilege, not a right, in the United States. Not everyone can afford therapy or insurance co-pays, nor does everyone have access to reliable internet or devices with video function. This makes teletherapy less feasible for older folks and poor people.
Murphy says virtual sessions work well for individuals with mild symptoms, meaning lower anxiety levels or less debilitating depression.
But high-risk populations, like those experiencing hallucinations or children with short attention spans, may find them challenging.
“Teletherapy has been more difficult for my consumers under the age of 12 because they’re looking all around, asking me 101 questions,” Murphy says.
And some individuals aren’t comfortable unpacking certain traumas at home, which proves tricky during the pandemic. Murphy counsels people who live in toxic environments but are unable to leave – a consequence of the stay-at-home orders.
To get around this, she suggests her consumers sit in the car and FaceTime her or walk around the block and call her. But those settings are far away from the Pavlovian cues of Murphy’s office.
Teletherapy has its advocates, converts and skeptics.
Regardless of stance, the rise in virtual counseling illuminates a larger trend: the fragility of our mental wellbeing during this global health crisis.
“It’s important to talk about mental illness openly because it makes a safe space for other people who may be going through it and either don’t realize it or don’t understand they need help,” Bunch says.
This type of safe space, not the brown velvet couch or its at-home re-creation but room to ask for support, may be the most important of all.
